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Florida Medicaid managed care plans — the coverage offered to millions of the state’s low-income residents — scored in the middle on industry report cards assessing the quality of care people receive.
The National Committee on Quality Assurance (NCQA) released in September its 2024 report cards that rank commercial, Medicare, Medicaid, and plans offered on the federal health insurance exchange.
In Florida, no Medicaid managed care plan that contracts with the state earned more than 3.5 stars out of a possible 5, the website shows.
Four of the 10 Florida Medicaid HMOs listed in the report scored 3.5 on a scale of five: Aetna Better Health of Florida, AmeriHealth Caritas, Molina Healthcare Florida, and UnitedHealthcare of Florida, which operates as UnitedHealthcare Community Plan.
Another four plans scored 3s: Humana Medical Plan Inc., Simply Healthcare Plans, the South Florida Community Care Network (which operates as Community Care Plan), and Sunshine State Health Plan.
Molina Healthcare of Florida (SMI), a specialty plan for Medicaid beneficiaries with serious mental illnesses, scored a 2.5.
Florida Community Care Plan (as distinct from the South Florida care network) is accredited by the American Association for Ambulatory Health Care. It did not report data to the NCQA and does not have a report card score.
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NCQA’s annual report cards score plans from 0-5 in 0.5 increments.
The 2024 plan ratings are based on the weighted average of the results of three data sources. Two of those, the Healthcare Effectiveness Data and Information Set (HEDIS) data reported to NCQA and the Center for Medicare and Medicaid Services’ Health Outcomes Survey (HOS), assess clinical quality. The third data source, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), analyzes patient satisfaction. NCQA awarded bonus points based on accreditation.
Florida Association of Health Plans President and CEO Audrey Brown said improving health care quality and access remains a top priority for Florida’s contracted Medicaid managed care plans.
“Day in and day out, Florida’s health plans work to ensure they are providing Floridians with the right service, at the right time and place and in the most appropriate setting. This results in better care for members, as well as delivering value to the state,” Brown said in a written statement. “To this end, health plans are continually implementing programs aimed at driving improvement in Florida’s HEDIS scores.”
Brown said that while measuring quality is critically important it also can be difficult.
“Methodologies change over time, and the subsets of populations included in the assessments change rapidly. For example, in Medicaid, members don’t always stay members for long periods of time. Quality scores fundamentally reflect a certain perspective at a certain point in time. As such, HEDIS scores alone are not a complete assessment of the quality and delivery of care,” she said.
Inside look at the numbers
UnitedHealthcare did a better job than its Florida competitors in immunizing adults against the flu, tetanus, diphtheria, shingles, and pneumonia, earning scores of 2, 3, 3, and 2, respectively.
Four of the plans — Aetna, Simply, Community Care, and Sunshine —scored the lowest, earning 1s across the board for adult immunizations against those diseases and viruses.
Molina Healthcare of Florida bested other plans in immunizing children. It earned 4s for adhering to vaccination recommendations for children under two and adolescents.
None of the plans scored higher than 2.5 in the behavioral health coordination category, which tracks follow up care provided to people admitted to an emergency room or inpatient setting for either mental illness or substance abuse.
Likewise, none of the plans scored higher than 2.5 in the women’s reproductive category, which includes information on prenatal care, postnatal care, and prenatal immunizations. Four of the plans — Molina, Molina SMI, Simply, and Sunshine — scored 1.5
New Medicaid managed care contracts
Florida requires most of its Medicaid enrollees to use managed care plans. To help ensure the state is getting the best value and care for its beneficiaries, state law requires competitive bids. Managed care plans compete against each other in hopes of securing six-year contracts worth billions of dollars annually and tens of billions over the life of the contract.
The NCQA released the report cards after the state completed its most recent negotiations with the health plans. The state agreed to contract with all the aforementioned health plans except for AmeriHealth Caritas, which earned a 3.5 on the 2024 report card.
The Agency for Health Care Administration, which houses Florida’s Medicaid program, did not immediately respond to a request for comment on the health plans’ performances.
Although no Florida contracted Medicaid managed care plan earned more than 3.5 stars, that’s not true elsewhere.
Nationally, 45 Medicaid managed care plans earned 4 stars, and Wisconsin had the most Medicaid plans (seven) that earned 4 stars followed by Pennsylvania (6), and California (5).
FAHP’s Brown cautioned against comparing plans from different states.
“Comparing Florida to other states is apples to oranges. Different states have different quality assessment schemes, different demographics, geographies, and more,” Brown said.
She added: “Health plans take the HEDIS scores seriously and will continue to work with our state partners to adopt innovative solutions to boost care accessibility and engage Floridians in order to continue to support healthier communities.”
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